title: Does thoracoscopic congenital diaphragmatic hernia repair cause a significant intraoperative acidosis when compared to an open abdominal approach?
abstract: OBJECTIVE
  Thoracoscopic congenital diaphragmatic hernia (CDH) repair is increasingly reported. A significant intraoperative acidosis secondary to the pneumocarbia, as well as an increased recurrence rate, are possible concerns. Our aim was to review our early experience of the technique.
  
  
  METHODS
  A prospective and retrospective data collection was carried out on all patients undergoing either an open or thoracoscopic CDH repair for a 4-year period. Preoperative blood gas values were identified at various stages of the operative procedure. A pH of 7.2 was considered to be a significant acidosis. The duration of surgery, complications, and recurrence rates were also recorded. Data were analyzed using the Mann-Whitney U test, and a P value of .05 or less was considered significant.
  
  
  RESULTS
  Twenty-two patients were included. One death occurred before surgery. Twelve patients underwent thoracoscopic repair (8 neonatal), and 9 underwent open repair (8 neonatal). There were 9 left-sided defects in the thoracoscopic group and 9 in the open group. Operative time was longer in the thoracoscopic group compared to the open group (median, 135 vs 93.5 minutes; P = .02). Neonates undergoing thoracoscopic repair were heavier compared to the open group (median, 3.9 vs 2.9 kg; P = .05), and their preoperative requirements for ventilation and inotropes were comparable. However, the association between those patients who required preoperative inotropes and those who required a patch repair was statistically significant P = .03. Two patients in each group developed an intraoperative acidosis. A further patient in the thoracoscopic group had a severe acidosis present at the beginning of surgery. There was no statistical difference in pH values or recurrence rate between the 2 groups. All recurrences were in patients requiring patch repairs. No postoperative mortality occurred.
  
  
  CONCLUSIONS
  We present our early experience of thoracoscopic CDH repair. Our results from thoracoscopic repair appear similar to the open procedure performed over the same period. No clear difference in intraoperative pH or recurrence rate has been demonstrated in our series. There is a need for a multicenter prospective study to establish the longer term outcome of this technique.
authors.affiliation: Department of Paediatric Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK. juliafishman@yahoo.co.uk
authors.forename: Julia R
authors.initials: JR
authors.lastname: Fishman
authors.forename: Simon C
authors.initials: SC
authors.lastname: Blackburn
authors.forename: Niall J
authors.initials: NJ
authors.lastname: Jones
authors.forename: Nicholas
authors.initials: N
authors.lastname: Madden
authors.forename: Diane
authors.initials: D
authors.lastname: De Caluwe
authors.forename: Munther J
authors.initials: MJ
authors.lastname: Haddad
authors.forename: Simon A
authors.initials: SA
authors.lastname: Clarke
mesh_terms: D000015:Abnormalities, Multiple; D000138:Acidosis / Q000097:blood / Q000209:etiology*; D002245:Carbon Dioxide / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics; D006548:Hernia, Diaphragmatic / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D007327:Insufflation; D007431:Intraoperative Complications / Q000097:blood / Q000209:etiology*; D007813:Laparotomy / Q000706:statistics & numerical data; D010100:Oxygen / Q000097:blood; D011031:Pneumothorax, Artificial / Q000009:adverse effects; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000009:adverse effects* / Q000706:statistics & numerical data
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen